Most young people who misuse prescription painkillers said they started doing so before they reached their senior year of high school, researchers found.

Action Points

Most U.S. kids start misusing prescription painkillers before they reach their senior year of high school.

Note that the risk of extramedical use of prescription pain relievers appears to be lowest from ages 12 to 14, and again from ages 19 to 21.

Most young people who misuse prescription painkillers said they began doing so before they reached their senior year of high school, researchers found.

An estimated 3% of kids in a national survey were classified as newly incident users and said they started using these drugs at age 16, the highest proportion among all age groups in the study, James Anthony, PhD, of Michigan State University in East Lansing, and colleagues reported online in the Archives of Pediatrics & Adolescent Medicine.

"We suspect that many physicians ... will share our surprise that for youth in the United States, the peak risk of starting extramedical use of prescription pain relievers generally occurs before the final year of high school, not during the [college] years," they wrote.

To determine when youth are most likely to start using prescription painkillers nonmedically, Anthony and colleagues looked at data from the National Survey on Drug Use and Health (NSDUH) 2004-2008, totaling 138,729 teens and adolescents ages 12 to 21.

They found that the greatest risk for starting to misuse these drugs occurred at age 16, when an estimated 2.8% become new users.

Even though an estimated 1 in 60 kids starts misusing prescription painkillers between ages 12 and 21, the estimate rises to 1 in 30 to 40 at age 16, the researchers reported.

Risk appears to be lowest from ages 12 to 14, and again from ages 19 to 21, they found. At age 12, for instance, only 0.5% reported new nonmedical use of prescription painkillers, as did 1.1% of 21-year-olds.

Anthony and colleagues noted that 2008 stood out as the year with the highest proportion of newly incident users across all age groups.

They said the findings imply that initiatives to prevent youth from misusing prescription painkillers that start around senior year of high school may be insufficient.

"With a peak risk at age 16 years and a notable acceleration in risk between ages 13 and 14 years, any strict focus on college students or 12th graders might be an example of too little too late," they wrote.

The study was limited by its reliance on self-reported data in the NSDUH database and some youth who engage in extramedical use of painkillers may have declined to participate in the survey. Still, they concluded that both public-health and practice-based strategies to prevent misuse are needed earlier in the adolescent years.

The study was supported by grants from the National Institute on Drug Abuse and Michigan State University.

Anthony has received honoraria, scientific advisory board compensation, and consultation fees as a consultant for the FDA and for CRS Associates.

Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

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